Health Psychology. Michael Murray
Refugees and asylum seekers
According to the United Nations Report (2017), over 65.3 million people were forcibly displaced worldwide in 2015. Nearly 21.3 million were refugees, the majority of whom were under the age of 18. More than half of the refugees came from war-stricken countries such as Syria (4.9 million), Afghanistan (2.7 million) and Somalia (1.1 million), with nearly 34,000 people fleeing their homes as a result of violence and conflict every day. This is the highest level of displacement on record.
The living conditions of refugees are bleak. Based on a study of 150,000 Syrian refugees living in camps in Jordan in 2014, nearly two-thirds were living below the national poverty line. Access to heating, reliable electricity and adequate sanitation were also problematic (United Nations High Commissioner for Refugees (UNHCR), 2014). It is no wonder that the physical and psychological well-being of refugees are impeded by these circumstances.
Communicable diseases are major causes of morbidity among refugees. Children under the age of 5 are most vulnerable, with cases of measles, respiratory tract infections, diarrhoea and severe acute malnutrition soaring at high levels. The risk of anaemia is also a challenge for refugee women and children. The psychological and social well-being of refugees is also a cause for concern. A systematic review exploring the psychosocial challenges of Syrian refugees in Jordan showed that psychological distress was generally experienced by refugees and was often exacerbated by environmental (e.g., financial, housing, employment) issues and psychosocial outcomes (e.g., loss of role and social support, inactivity) (Wells et al., 2016). Furthermore, in a recent study investigating the prevalence of insomnia among refugees in Jordan, it was found that the majority of refugees had moderate to severe insomnia. Incidence of insomnia was predicted by factors such as older age, living in the city of Mafraq, poor education, unemployment, and lack of access to medication (Al-Smadi et al., 2017).
Understanding the experiences of refugees and asylum seekers is important in informing plans to alleviate these issues. Participatory engagement and ethical reporting are necessary to ensure that recommendations are based on evidence that is meaningful and useful on the ground. For example, McCarthy and Marks (2010) facilitated participatory action research to explore the health and well-being of refugee and asylum-seeking children. The research process suggests that although young refugees often face many challenges in their new life, they are able to find enough strength and resilience to cope with these issues. Similarly, Haaken and O’Neill (2014) used participatory visual methods to explore the experiences of women migrants and asylum seekers in the UK. Through photography and videography, participants were able to share their stories of seeking refuge in the UK. As an outcome of the project, a 10-minute video was developed which conveyed the complexities of the asylum process and also reflected historical and social dynamics of their experiences.
Culturally Competent Health Care Systems
In the ever-changing demographic and cultural trends of ‘globalized’ society, health care systems need to be able to adapt flexibly to such changes and develop cultural competence. Culturally competent health care involves developing (1) culturally sensitive staff who are able to reflect on their own beliefs and practices and acknowledge diversity in the community, and (2) culturally appropriate materials, activities and systems that address linguistic, cultural and social barriers. Cultural competence in health care asserts the importance of health service users and providers being able to communicate clearly with each other. Training health care professionals to develop skills that enable them to deal with communication issues associated with cultural, linguistic and health literacy differences may be a good way to reduce inequities in health (Lie et al., 2012). Culturally competent health care systems can do this by helping health care professionals to develop cultural sensitivity, knowledge and skills and by instilling processes that will enable them to engage meaningfully with culturally diverse patients. Systematic reviews suggest that interventions that aim to improve cultural competence among health care professionals can help to increase their knowledge of cultural issues in health care (Renzaho et al., 2013) and improve patient and clinical health outcomes (Truong et al., 2014).
In addition to culturally competent health care, diversity and inclusivity can be promoted in other social contexts. For example, Andreouli et al. (2014) explored the role of schools in promoting inclusive communities. The authors argued that intercultural exchange can be promoted by examining how communities resist stigma and discrimination on a local level. While starting on a micro level, such approaches can be endorsed to build the foundations of health-promoting communities.
Future Research
1 Through access to historical documents, research psychologists can assist our understanding of the evolution of health beliefs.
2 Understanding popular health beliefs requires an appreciation of their social and cultural context.
3 The increasing development of alternative health care in Western society requires ongoing research.
4 The comprehensive and accurate measurement of perceived discrimination and its mechanisms, which contribute to poor health, require examination.
Summary
1 Human thought and practices are culturally immersed.
2 The Western view of health has moved through various stages from the classic to the religious and then the scientific.
3 The scientific view of health, or biomedicine, is the dominant view in contemporary society but other health belief systems remain popular.
4 Traditional Chinese Medicine remains popular in China and among Chinese migrants in other societies.
5 Ayurvedic medicine remains popular in parts of Southern Asia.
6 In Africa a wide variety of health belief systems emphasize spiritual aspects and a communal orientation.
7 In contemporary society there is increasing interest in various complementary and alternative (CAM) therapies, such as herbal medicine, homeopathy, aromatherapy and reflexology.
8 While debates are ongoing about the efficacy of CAM, guidelines and policies are being developed to ensure quality and safety.
9 Interventions aiming to promote indigenous health need to reflect the holistic notion of health among these communities and the voice of the community itself.
10 Racism continues to contribute to poor health among migrants, ethnic minority groups and indigenous peoples.
11 Culturally competent health care must aim to adapt to changing demographic and cultural trends.
7 An A–Z of Research Methods and Issues Relevant to Health Psychology
‘Be curious.’
Anon
Outline
In this chapter, we present an A–Z of methods and issues within health psychology research in four categories: quantitative, qualitative, action research, or mixed. Quantitative researchers place an emphasis on reliable and valid measurement in controlled experiments, trials and surveys. Qualitative researchers use interviews, focus groups, narratives, diaries, texts or blogs to explore health and illness concepts and experiences. Action researchers facilitate change processes, improvement, empowerment and emancipation. Mixed methods researchers combine methods from different traditions. This chapter also introduces issues that are crucial to the progression of the field, such as replication, power and repeatability.
Introduction
Curiosity is the overarching motive for any piece of research. We always want to know more, to better understand how things work. Researchers are generating an increasingly diverse array of questions that require equally diverse methods to answer them. Inevitably publications end with more questions than answers and conclude with the statement that more research is needed. Theories play a crucial role in guiding our curiosity along worthwhile avenues. We need to go where the field is most fertile, and